Process as a predictor of Outcomes in CBT for Youth

描述（由申请人提供）：焦虑症是常见的，如果不治疗，会影响儿童的生活。在随机临床试验（RCT）中，研究表明认知行为疗法（CBT）对患有焦虑症的青少年有益。我们目前正在比较个人CBT、家庭CBT和教育/支持/关注条件。尽管对结果的研究有所增加，但对治疗过程的研究却很少。通过对154例在之前的随机对照试验中接受单独CBT治疗的病例和当前试验中的50例进行录音和录像，我们将研究过程变量和CBT治疗结果之间的关系。过程变量是(1)治疗联盟，(2)儿童参与和(3)治疗师对手工治疗的灵活性。这三个变量将从会话1-4（早期过程）和会话5-8（后期过程）对整个数据集进行测量。此外，将对当前RCT中50个病例的9-16期的三个过程变量进行测量。评分者将使用儿童心理治疗过程量表、儿童参与评定量表和修改后的协议依从性检查表，从总共1600次的个体CBT治疗中，每次对整个疗程进行三分之一的评分。假设一个强大的治疗联盟和高水平的儿童参与将预测积极的治疗结果。对中介影响的识别（例如，后期介入，治疗师的灵活性）将进一步使结果研究者和实践临床医生更好地理解治疗与有益结果累积之间的因果机制。为了评估导致患者流失的潜在过程变量，我们将比较完成治疗的儿童和停止治疗的儿童的早期过程变量。假设非完成者的联盟、灵活性和参与程度较低。

DESCRIPTION (provided by applicant): Anxiety disorders are common and, if untreated, influence children's lives. In randomized clinical trials (RCT), research has shown that cognitive behavioral therapy (CBT) benefits anxiety-disordered youth. We are currently comparing individual CBT, family CBT, and an education/support/attention condition. Though there has been an increase in outcome research, there has been very little study of the treatment process. With audio and video taped sessions from 154 cases that have received individual CBT in previous RCTs and 50 cases from the current trial, we will examine the relations between process variables and treatment outcome within CBT. The process variables are (1) therapeutic alliance, (2) child involvement and (3) therapist flexibility with the manual-based treatment. These three variables will be measured from sessions 1-4 (earlier process) and sessions 5-8 (later process) for the entire data set. In addition, the three process variables will be measured from sessions 9-16 for the 50 cases in the current RCT. Raters will rate the entire sessions a third at a time from a total of 1600 sessions of individual CBT using the Child Psychotherapy Process Scale, Child Involvement rating scales and the Modified Protocol Adherence Checklist. It is hypothesized that a strong therapeutic alliance and high levels of child involvement will predict positive treatment outcome. The identification of mediating influences (e.g., later involvement, therapist flexibility) will further enable the outcome researcher and the practicing clinician to develop a better understanding of the causal mechanisms between therapy and the accrual of beneficial outcomes. To evaluate potential process variables that contribute to patient attrition, we will compare the early process variables for children completing treatment and those who discontinue. It is hypothesized that non-completers will have the experienced lower levels of alliance, flexibility, and involvement.